Download Today and Tomorrow

Estelle Camus, PhD
IntraCardiac Echo Imaging: Today and Tomorrow
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Answers for life.
FACULTY/PRESENTER DISCLOSURE
• Faculty: Estelle Camus
• Relationships with commercial interests:
- Grants/Research Support: N/A
- Speakers Bureau/Honoraria: N/A
- Consulting Fees: N/A
- Other: Employee of Siemens Healthcare
Unrestricted © Siemens AG 2015 All rights reserved.
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2015-02
Estelle Camus – 12th Winter Arrhythmia School
Intra-Cardiac Echocardiography
Portfolio and History
3D ICE
2D ICE
Volume ICE*
* Distributed by Siemens
AcuNav™ V
10F
SoundStar™
10F
AcuNav™ 8F
SoundStar™ eco
8F
SoundStar™ eco
10F
AcuNav™ 10F
Unrestricted © Siemens AG 2015 All rights reserved.
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2015-02
Estelle Camus – 12th Winter Arrhythmia School
Catheters and Ultrasound Systems Compatibility
ACUSON
Cypress™
ACUSON
X300™,
Premium Edition
ACUSON
X700™
ACUSON
Sequoia™
ACUSON
SC2000™
ACUSON S
Family™
ACUSON AcuNav™ ultrasound catheter (8F, 10F)
SoundStar™ (10F, eco 10F, eco 8F)
ACUSON
AcuNav V™
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2015-02
Estelle Camus – 12th Winter Arrhythmia School
Clinical Applications for 2D/3D ICE and Volume ICE
Expanding to Additional Clinical Disciplines
Established
Electrophysiology
 Atrial Fibrillation
Ablation (Radiofrequency)
Emerging
Interventional
Cardiology
Percutaneous Valve
Interventions
Interventional
Radiology
 Atrial Septal Defect
(ASD)
 Aortic Valve (TAVR)
 Direct Intrahepatic
Portosystemic
Shunt (DIPS)
 Cryoablation
 Patent Foramen
Ovale (PFO)
 Ventricular
Tachycardia
Ablation
 Left Atrial
Appendage Closure
(LAA)
 Mitral Valve
 Pulmonary Valve
 Tricuspid Valve
Unrestricted © Siemens AG 2015 All rights reserved.
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2015-02
Estelle Camus – 12th Winter Arrhythmia School
AcuNav™ and SoundStar™
Real-Time 2D ICE Catheter Solutions
 Side-firing ultrasound catheter
 8F or 10F
 90 cm
 Real-time 2D imaging (B, Color)
 PW, CW modes
 4-way 160°steering
 Anterior / Posterior
 Left / Right
 Allows imaging of left heart from right heart
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2015-02
Estelle Camus – 12th Winter Arrhythmia School
Indication for Use
"The ACUSON ACUNAV™ Ultrasound Catheter is
intended for intra-cardiac and intra-luminal
visualization of cardiac and great vessel anatomy
and physiology, as well as visualization of other
devices in the heart of adult and pediatric patients”
Unrestricted © Siemens AG 2015 All rights reserved.
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2015-02
Estelle Camus – 12th Winter Arrhythmia School
AcuNav™ and SoundStar™
Bringing Benefits to Interventional Procedures
Clinical Benefits
 Visualization of anatomy and devices
 Conscious sedation vs. general anesthesia
 Reduced fluoroscopy and contrast doses
 Improved patient safety and recovery
Workflow Benefits
SoundStar
 Reduced procedural time
 Image guidance by single operator
Financial Benefits
 Increased patient volume
 Reduced staffing need
 Reduced need for more invasive imaging modalities
AcuNav
Unrestricted © Siemens AG 2015 All rights reserved.
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2015-02
Estelle Camus – 12th Winter Arrhythmia School
Cavo-Tricuspid Isthmus and RVOT
RA
AO
RA
RV
RVOT
RV
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Page 9
2015-02
Courtesy of Biosense Webster’s Inc.
Estelle Camus – 12th Winter Arrhythmia School
Left and Right Pulmonary Veins
RSPV
LA
RIPV
LSPV
LIPV
Unrestricted © Siemens AG 2015 All rights reserved.
Page 10
2015-02
Courtesy of Biosense Webster’s Inc.
Estelle Camus – 12th Winter Arrhythmia School
Left Atrial Appendage and Esophagus
LA
LAA
LV
ESO
Unrestricted © Siemens AG 2015 All rights reserved.
Page 11
2015-02
Courtesy of Biosense Webster’s Inc.
Estelle Camus – 12th Winter Arrhythmia School
Left Ventricular Long Axis View
Pericardial Effusion
LA
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Page 12
2015-02
LV
Courtesy of Biosense Webster’s Inc.
Estelle Camus – 12th Winter Arrhythmia School
ACUSON AcuNav™ V Catheter*
World’s First Real-Time Volume ICE Catheter
 10F
 90 cm
 Volume size: 24°x 90° volume
 Real-time volume imaging (B, Color)
 Powered by ACUSON SC2000 system
 Superior visualization of anatomy and devices over 2D ICE
 Real-time 3D color provides valuable blood flow information
 “Flashlight in the heart”
Unrestricted © Siemens AG 2015 All rights reserved.
Page 13
2015-02
* Distributed by Siemens
Estelle Camus – 12th Winter Arrhythmia School
ACUSON AcuNav™ V Catheter*
World’s First Real-Time Volume ICE Catheter
Clinical Benefits
 Superior visualization of anatomy and devices over 2D ICE
 Conscious sedation vs. general anesthesia
 Reduced fluoroscopy and contrast doses
 Improved patient safety and recovery
Workflow Benefits
 Reduced procedural time
 Image guidance by single operator
Financial Benefits
 Increased patient volume
 Reduced staffing need
 Reduced need for more invasive imaging modalities
Unrestricted © Siemens AG 2015 All rights reserved.
Page 14
2015-02
Courtesy of Mayo Clinic Rochester, MN
* Distributed by Siemens
Estelle Camus – 12th Winter Arrhythmia School
ACUSON AcuNav™ V Catheter
Superior Visualization of Tissue and Needle
Transeptal
Puncture
Unrestricted © Siemens AG 2015 All rights reserved.
Page 15
2015-02
Courtesy of Yale Medical Center, New Haven, CT
Estelle Camus – 12th Winter Arrhythmia School
ACUSON AcuNav™ V Catheter
Superior Visualization of Pulmonary Veins and Lasso Catheter
Unrestricted © Siemens AG 2015 All rights reserved.
Page 16
2015-02
Courtesy of Stanford Medical Center, Palo Alto, CA
Estelle Camus – 12th Winter Arrhythmia School
ACUSON AcuNav™ V Catheter
Superior Visualization of Pulmonary Vein for RF Ablation
Unrestricted © Siemens AG 2015 All rights reserved.
Page 17
2015-02
Courtesy of Mayo Clinic Rochester, MN
Estelle Camus – 12th Winter Arrhythmia School
ACUSON AcuNav™ V Catheter
Successful Guidance of Cryoablation
Unrestricted © Siemens AG 2015 All rights reserved.
Page 18
2015-02
Courtesy of Stanford Medical Center, Palo Alto, CA
Estelle Camus – 12th Winter Arrhythmia School
ACUSON AcuNav™ V Catheter
Benefits of the ACUSON AcuNav V™ Ultrasound Catheter
 Improved visualization of anatomy and devices with real time 3D imaging
 Safer and faster procedures
 3D color flow Doppler provides immediate evaluation of outcomes
 Seamless integration into today and tomorrow’s EP and structural heart programs
Benefit Comparison to Transesophageal Echocardiography
 Single operator procedure
 Ideal platform for guiding procedures and continuous monitoring
 Reduced need for general anesthesia reducing costs and complications
 Dramatic improvement in patient comfort especially during long procedures
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2015-02
Estelle Camus – 12th Winter Arrhythmia School
What comes
tomorrow?
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Page 20
2015-02
Estelle Camus – 12th Winter Arrhythmia School
Next Generation Volume ICE*
Pioneering on Echo Guidance of Minimally Invasive Procedures
Unrestricted © Siemens AG 2015 All rights reserved.
Page 21
2015-02
*Works in Progress – Not Commercially Available
Estelle Camus – 12th Winter Arrhythmia School
Tissue Characterization with Acoustic Radiation Force Imaging (ARFI)
 Radiation-force applied to tissue
at the focus, creates µm scale
tissue displacements inversely
proportional to the tissue
mechanical properties
 Ultrasound scan lines monitor
tissue response
 Multiple lateral push locations
are acquired to build a 2D image
 2D images of ARFI-induced
displacements provide
visualization of relative tissue
elasticity
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Page 22
2015-02
Gap
RFA
RFA
RF-induced tissue heating increases tissue stiffness:
 RFA lesion = relatively low displacements
 Unablated myocardium = relatively high displacements
*Works in Progress – Not Commercially Available
Estelle Camus – 12th Winter Arrhythmia School
ARFI Clinical Study – Preliminary Results*
 11 Patients (8 atrial fibrillation, 2 atrial flutter, 1 atypical flutter)
 Previous studies indicate ARFI-induced displacements are due to
thermocoagulation, not edema
Ablation of Tricuspid Annulus for Atrial Flutter
 Successful imaging and tricuspid annulus
 Final ARFI image showed complete linear ablation
 EP study showed block at annulus
LA
RA
RV
LV
Successive imaging
of ablation along LA
roof line
Pulmonary vein isolation

Successful imaging around pulmonary veins
Ligament of Marshall
 Typically difficult to achieve sufficient contact force
 Successful imaging location in most preliminary patients
TD Bahnson, SA Eyerly, PJ Hollender, JR Dorhety, YJ Kim, GE Trahey, PD Wolf. Feasibility of Near Real-Time
Lesion Assessment during Radiofrequency Catheter Ablation in Humans using Acoustic Radiation Force
Impulse Imaging. Journal of Cardiovascular Electrophysiology, 2014, Vol 25 (12), p. 1275-1283
Unrestricted © Siemens AG 2015 All rights reserved.
Page 23
2015-02
*Works in Progress – Not Commercially Available
Estelle Camus – 12th Winter Arrhythmia School
Questions
Unrestricted © Siemens AG 2015 All rights reserved.
Answers for life.